Provider Demographics
NPI:1518925841
Name:TEGALA, BENARJI (MD)
Entity Type:Individual
Prefix:DR
First Name:BENARJI
Middle Name:
Last Name:TEGALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:TEGALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1211 E 6TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4095
Mailing Address - Country:US
Mailing Address - Phone:903-640-4700
Mailing Address - Fax:903-640-1975
Practice Address - Street 1:1211 E 6TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4095
Practice Address - Country:US
Practice Address - Phone:903-640-4700
Practice Address - Fax:903-640-1975
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9264207R00000X
LA13587R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1434469Medicaid
LA5H381Medicare ID - Type Unspecified
LAH18925Medicare UPIN